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Regional anesthesia anticoagulation guidelines

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https://www.readbyqxmd.com/read/28526159/anticoagulation-and-neuraxial-peripheral-anesthesia
#1
REVIEW
Mudit Kaushal, Ryan E Rubin, Alan D Kaye, Karina Gritsenko
Novel anticoagulants (NAGs) have emerged as the preferred alternatives to vitamin K antagonists. In patients being considered for regional anesthesia, these drugs present a layer of complexity in the preprocedure evaluation. There are no established tests to monitor anticoagulant activity and our experience is short with these drugs. These authors believe it is important to review the relevant hematology, orthopedics, and anesthesiology literature to provide a valuable reference for the clinician who is met with these challenges...
June 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28526151/novel-anticoagulant-agents-in-the-perioperative-setting
#2
REVIEW
Allyson Lemay, Alan D Kaye, Richard D Urman
An increasing number of oral anticoagulants have become available over the past decade. Each of these agents has differing implications on both regional and neuraxial anesthetic techniques. This article describes the pharmacology, pharmacokinetics, and pharmacodynamics of the most commonly used novel oral anticoagulants (NOACs). It also outlines recent guidelines for the use of NOACs in the perioperative setting, especially with regard to neuraxial anesthesia.
June 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28492441/residual-enoxaparin-activity-anti-xa-levels-and-concerns-about-the-american-society-of-regional-anesthesia-and-pain-medicine-anticoagulation-guidelines
#3
Daryl S Henshaw, James D Turner, Daniel J Forest, Garrett R Thompson, Robert S Weller
Currently, the American Society of Regional Anesthesia and Pain Medicine (ASRA) anticoagulation guidelines recommend that before the performance of a neuraxial procedure a minimum of 24 hours should elapse following a treatment dose of enoxaparin (1 mg/kg twice daily or 1.5 mg/kg once daily). The guidelines have since their inception also consistently recommended against the routine use of anti-Xa level monitoring for patients receiving enoxaparin. However, we noted in our clinical practice that anti-Xa levels were frequently still elevated despite patients meeting the time-based recommendation for treatment dose enoxaparin...
May 10, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28360531/a-review-and-survey-of-policies-utilized-for-interventional-pain-procedures-a-need-for-consensus
#4
Lynn Kohan, Reza Salajegheh, Robin J Hamill-Ruth, Sandeep Yerra, John Butz
BACKGROUND: Other than the newly published anticoagulation guidelines, there are currently few recommendations to assist pain medicine physicians in determining the safety parameters to follow when performing interventional pain procedures. Little information exists regarding policies for oral intake, cumulative steroid dose limits, driving restrictions with and without sedation, and routine medication use for interventional procedures. METHODS: A 16-question survey was developed on common policies currently in use for interventional pain procedures...
2017: Journal of Pain Research
https://www.readbyqxmd.com/read/28339551/anticoagulant-and-antiplatelet-management-for-spinal-procedures-a-prospective-descriptive-study-and-interpretation-of-guidelines
#5
Bradly S Goodman, L McLean House, Sridhar Vallabhaneni, Srinivas Mallempati, Matthew R Willey, Matthew Thomas Smith
Setting.:  Epidural hematoma rarely complicates interventional spine procedures. While anticoagulant and antiplatelet drugs increase bleeding risk, cessation may precipitate serious thromboembolic events. The Spine Intervention Society (SIS) and American Society of Regional Anesthesia and Pain Medicine (ASRA) put forth guidelines that dissent with regard to management of hemostatically active agents during commonly performed spinal injections. Objective.:  To validate an antiplatelet/anticoagulant management table based on modifications of the SIS 2013 and ASRA 2015 guidelines...
October 6, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/27982554/regional-anaesthesia-and-antithrombotic-agents-instructions-for-use
#6
Gennaro Scibelli, Lucia Maio, Gennaro Savoia
BACKGROUND: The use of anticoagulant agents represents a serious limitation of regional anesthesia, due to the risk of spinal hematoma. Examining all the principles currently available, it has been possible to notice that published guidelines are very often incomplete or also differ significantly on the rules to be followed relating to a specific drug. METHODS: We have carried out a comparison between the guidelines of major scientific societies in order to take a practical and simple user guide which operators can consult...
March 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/27900415/-management-of-anesthesia-in-endovascular-interventions
#7
REVIEW
T Rössel, R Paul, T Richter, S Ludwig, T Hofmockel, A R Heller, T Koch
Cardiovascular diseases are one of the leading causes of morbidity and mortality in Germany. In these patients, the high-risk profile necessitates an interdisciplinary and multimodal approach to treatment. Endovascular interventions and vascular surgery have become established as an important element of this strategy in the past; however, the different anatomical localizations of pathological vascular alterations make it necessary to use a wide spectrum of procedural options and methods; therefore, the requirements for management of anesthesia are variable and necessitate a differentiated approach...
December 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27536909/paraplegia-after-thoracic-epidural-steroid-injection
#8
Vivek Loomba, Hirsh Kaveeshvar, Samvid Dwivedi
Epidural steroid injections are a common procedure performed by pain physicians. The American Society of Regional Anesthesia along with several other groups recently provided guidelines for performing epidural injections in the setting of anticoagulants. We present a case of a patient who developed an epidural hematoma and subsequent paraplegia despite strict adherence to these guidelines. Although new guidelines serve to direct practice, risks of devastating neurologic complications remain as evidenced by our case...
September 1, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27290980/use-of-direct-oral-anticoagulants-with-regional-anesthesia-in-orthopedic-patients
#9
REVIEW
Gianluca Cappelleri, Andrea Fanelli
The use of direct oral anticoagulants including apixaban, rivaroxaban, and dabigatran, which are approved for several therapeutic indications, can simplify perioperative and postoperative management of anticoagulation. Utilization of regional neuraxial anesthesia in patients receiving anticoagulants carries a relatively small risk of hematoma, the serious complications of which must be acknowledged. Given the extensive use of regional anesthesia in surgery and the increasing number of patients receiving direct oral anticoagulants, it is crucial to understand the current clinical data on the risk of hemorrhagic complications in this setting, particularly for anesthesiologists...
August 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27076369/initial-experience-of-the-american-society-of-regional-anesthesia-and-pain-medicine-coags-regional-smartphone-application-a-novel-report-of-global-distribution-and-clinical-usage-of-an-electronic-decision-support-tool-to-enhance-guideline-use
#10
Rajnish K Gupta, Matthew D McEvoy
BACKGROUND AND OBJECTIVES: Decision support tools have been demonstrated to improve adherence to medical guidelines; however, smartphone applications (apps) have not been studied in this regard. In a collaboration between Vanderbilt University and the American Society of Regional Anesthesia and Pain Medicine (ASRA), the ASRA Coags Regional app was created to be a decision support tool for the 2010 published guideline on regional anesthesia for patients receiving anticoagulation. This is a review of the distribution and usage of this app...
May 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/26882272/periprocedural-management-of-direct-oral-anticoagulants-comment-on-the-2015-american-society-of-regional-anesthesia-and-pain-medicine-guidelines
#11
REVIEW
James D Douketis, Summer Syed, Sam Schulman
No abstract text is available yet for this article.
March 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/26347411/neuraxial-and-peripheral-nerve-blocks-in-patients-taking-anticoagulant-or-thromboprophylactic-drugs-challenges-and-solutions
#12
REVIEW
Jinlei Li, Thomas Halaszynski
Incidence of hemorrhagic complications from neuraxial blockade is unknown, but classically cited as 1 in 150,000 epidurals and 1 in 220,000 spinals. However, recent literature and epidemiologic data suggest that for certain patient populations the frequency is higher (1 in 3,000). Due to safety concerns of bleeding risk, guidelines and recommendations have been designed to reduce patient morbidity/mortality during regional anesthesia. Data from evidence-based reviews, clinical series and case reports, collaborative experience of experts, and pharmacology used in developing consensus statements are unable to address all patient comorbidities and are not able to guarantee specific outcomes...
2015: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/26135797/purple-glove-syndrome-after-phenytoin-or-fosphenytoin-administration-review-of-reported-cases-and-recommendations-for-prevention
#13
REVIEW
Lyudmila A Garbovsky, Byron C Drumheller, Jeanmarie Perrone
The aim of our study was to identify all previously reported cases of phenytoin- or fosphenytoin-associated purple glove syndrome (PGS) and summarize the most current understanding of the pathophysiology, clinical presentation, diagnosis, and treatment of the disease. We searched the English language references from MEDLINE, EMBASE, CINAHL, TOXNET, and gray literature that featured one or more case descriptions of phenytoin- or fosphenytoin-associated PGS after administration and provided information on the clinical setting of the event and associated outcome(s)...
December 2015: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
https://www.readbyqxmd.com/read/25899949/interventional-spine-and-pain-procedures-in-patients-on-antiplatelet-and-anticoagulant-medications-guidelines-from-the-american-society-of-regional-anesthesia-and-pain-medicine-the-european-society-of-regional-anaesthesia-and-pain-therapy-the-american-academy
#14
Samer Narouze, Honorio T Benzon, David A Provenzano, Asokumar Buvanendran, José De Andres, Timothy R Deer, Richard Rauck, Marc A Huntoon
Interventional spine and pain procedures cover a far broader spectrum than those for regional anesthesia, reflecting diverse targets and goals. When surveyed, interventional pain and spine physicians attending the American Society of Regional Anesthesia and Pain Medicine (ASRA) 11th Annual Pain Medicine Meeting exhorted that existing ASRA guidelines for regional anesthesia in patients on antiplatelet and anticoagulant medications were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors necessitated separate guidelines for pain and spine procedures...
May 2015: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/25899948/about-bloody-time-interventional-spine-and-pain-procedures-in-patients-on-antiplatelet-and-anticoagulant-medications-guidelines-from-the-american-society-of-regional-anesthesia-and-pain-medicine-european-society-of-regional-anaesthesia-and-pain-therapy-american
#15
EDITORIAL
https://www.readbyqxmd.com/read/25693330/-proposal-for-making-guidelines-of-regional-anesthesia-in-patients-under-anticoagulation-therapy-or-antiplatelet-therapy
#16
EDITORIAL
Shinsuke Hamaguchi
No abstract text is available yet for this article.
October 2014: Masui. the Japanese Journal of Anesthesiology
https://www.readbyqxmd.com/read/24565383/sba-recommendations-for-regional-anesthesia-safety-in-patients-taking-anticoagulants
#17
REVIEW
Neuber Martins Fonseca, Rodrigo Rodrigues Alves, João Paulo Jordão Pontes
No abstract text is available yet for this article.
January 2014: Brazilian Journal of Anesthesiology
https://www.readbyqxmd.com/read/24338124/reconsidering-the-switch-from-low-molecular-weight-heparin-to-unfractionated-heparin-during-pregnancy
#18
REVIEW
L D Pacheco, G R Saade, M M Costantine, R Vadhera, G D V Hankins
Venous thromboembolic disease accounts for 9% of all maternal deaths in the United States. In patients at risk for thrombosis, common practice is to start prophylactic doses of low-molecular-weight heparin and transition to unfractionated heparin during the third trimester, with the perception that administration of neuraxial anesthesia will be safer while on unfractionated heparin, as spinal/epidural hematomas have been associated with recent use of low-molecular-weight heparin. In patients receiving prophylactic doses of unfractionated heparin, neuraxial anesthesia may be placed, provided the dose used is 5,000 units twice a day...
September 2014: American Journal of Perinatology
https://www.readbyqxmd.com/read/24335403/new-oral-anticoagulants-and-regional-anaesthesia
#19
REVIEW
H T Benzon, M J Avram, D Green, R O Bonow
The new oral anticoagulants are approved for a variety of clinical syndromes, including the prevention of stroke in atrial fibrillation, acute coronary syndromes, treatment of venous thromboembolism (VTE), and prevention of venous thrombosis after total joint surgery or hip fracture. Published guidelines have differing recommendations on the safe interval between discontinuation of the anticoagulant and performance of neuraxial procedures and between the interventional procedure and redosing of the drug. While two to three half-life intervals might be acceptable in patients who are at high risk for VTE or stroke, an interval of four to six half-lives between discontinuation of the drug and neuraxial injections is probably safer in most patients at low risk of thrombosis...
December 2013: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/23905877/regional-anaesthesia-and-patients-with-abnormalities-of-coagulation-the-association-of-anaesthetists-of-great-britain-ireland-the-obstetric-anaesthetists-association-regional-anaesthesia-uk
#20
(no author information available yet)
Concise guidelines are presented that relate abnormalities of coagulation, whether the result of the administration of drugs or that of pathological processes, to the consequent haemorrhagic risks associated with neuraxial and peripheral nerve blocks. The advice presented is based on published guidelines and on the known properties of anticoagulant drugs. Four separate Tables address risks associated with anticoagulant drugs, neuraxial and peripheral nerve blocks, obstetric anaesthesia and special circumstances such as trauma, sepsis and massive transfusion...
September 2013: Anaesthesia
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